In a country where you can smell the wind aboard a Regional Express Train (TER), a stadium that dazzles any visitor and a cornice that shines the gloss of the Atlantic, in an era when the world is stamping its feet to embrace its meta-humanity, a flooded hospital might be the stuff of fiction. But there are still countries where these romantic scenes tell the story of everyday life. A little anesthesia to hold the shock.

We are in the month of July, in full wintering. Here, we don’t dance in the rain, because after it, instead of good weather, we see mud, damage, and tears drizzle as if to offer a refrain to the showers. In the Dakar capital and in the regions, the floods did not even spare the hospitals.

On Friday, July 8, 2022, heavy rain had filled the patient wards with water. Kolda Regional Hospital, 679 km south of Dakar. On July 22, rainwater kept a patient company in an operating theater inAristide Le Dantec Hospital in Dakar. Doctors were forced to turn into surface technicians. Saving a life by scraping water requires a lot of genius…

This alarming situation raises three fundamental questions: does Senegal provide enough resources to finance its health system? Are these resources being used optimally? Does the health system live up to the demands of its time?

First, Senegal endorsed provisions such as the 2001 Abuja declaration, which materializes the commitment of African Union countries to allocate at least 15% of their budget to the health sector, or the declaration of Tunis on July 5, 2012 of the Ministers of Finance and Health of African countries which commits them to accelerate Universal Health Coverage. If the share of health was only 8% of national budget in 2017, it moved to 10% in 2019. Although efforts are being made to improve this budget from year to year, the efficient use of resources remains a major challenge.

Senegal had, in 2019, according to data from the National Agency for Statistics and Demography (ANSD), 36 hospitals, seventy-nine (79) health districts, one hundred and three (103) health centers, one thousand four hundred and fifteen (1,415) health posts, two thousand six hundred and seventy-six (2,676) health huts. But we see that some of these health structures are in very dilapidated condition with precarious equipment. In order not to fall into the idolatry of numbers, it is useful to remember that paracetamol or the basic equipment for providing first aid are sometimes lacking in these structures, especially those in remote areas. This is the reason why, in the dictionary of the popular imagination, our hospitals are synonymous with places of death. Well validated at the academy of despair…

We could not talk about infrastructure without mentioning human resources. Not only are there health establishments without sufficient staff, hence the phenomenon of medical deserts, there is also a real geographical imbalance in the distribution of health actors. Dakar concentrates 36% of healthcare professionals more than a third at the national level. This unbalanced distribution explains the fact that certain sanitary installations exist only in name, without a qualified doctor and without maintenance.

Today, if we record certain accidents in the hospital environment, such as charred babies or flooded operating theatres, it is because the existing facilities are of poor quality. The buildings are in a state of disrepair, some having been built since the period of independence. Others are recently built, inaugurated with great fanfare, but poorly maintained.

This observation also calls into question the level of healthiness of health structures. In addition to the need to keep spaces that receive patients and staff clean, the management of biomedical waste remains problematic in several structures where old incinerators or artisanal ovens are still used, thus having a harmful effect on the environment.

Just through the state of the health infrastructure, it jumps to the eye all the symptoms of a seriously ill person who needs an infusion to upgrade.

Fight against corruption, diversify funding sources, and focus on maintenance

Senegal is one of the “champions” when it comes to adhering to protocols and conventions, and drafting plans. However, there is a poor monitoring-evaluation and sanction culture in the country.

As highlighted above, efforts are being made to increase the budget allocated to health, but the impacts on the system are not necessarily felt. So there is a need to tackle issues of corruption and accountability in the health system. In this regard, in the document published in February 2020 on improving health systemsfor the benefit of the populations, the citizen think tank WATHI recommended the establishment of “external and internal audits to ensure that budgets are allocated and spent in an adequate manner” and “the development of strict standards for controlling access to certain equipment to promote transparency and accountability” in order to fight corruption on a daily basis in the health sector.

To diversify the sources of financing, the resources drawn from taxes on products harmful to health, such as tobacco or alcohol, taxes on luxury goods and on financial transactions and possibly a special tax on the profits of big business.

In addition, the construction of modern hospitals is essential to the development of a country, but instead of political shovels, care should be taken to provide the populations with quality buildings with maintenance systems to ensure the sustainability. The maintenance service must therefore be considered as an essential organ in the operation of health establishments.

To overcome all these shortcomings in terms of physical facilities, using modern technologies could help establish transparent payment methods, a faster file processing system and facilitate the development of remote prevention and telemedicine in remote areas. in priority.

It is almost impossible to meet all these challenges without having a precise and up-to-date inventory of the needs of the health system. Today, it is difficult to have up-to-date data on the finances or the personnel of the health system. Therefore, this flaw could be corrected through the establishment of an institution responsible for carrying out research on the health system, identifying its strengths and weaknesses, and proposing areas for improvement for the implementation place of coherent and sustainable public policies.

Preparing the health system for the future

With a Senegalese population that could reach 28 million inhabitants by 2050, a urbanization rateexceeding the average in West Africa (40%), it is clear that lifestyles are changing. Consequently, pathologies linked to cardiovascular diseases, diabetes and cancer are more and more frequent. It is important for our health system to have a mechanism for monitoring the dynamics of the population that it will be called upon to take charge of in order to improve its reception capacities and invest more in prevention.

This forward-looking approach reminds us once again of the importance of research. The research results are not predictions but offer a range of possible situations or scenarios to better react to a situation or a crisis. This requirement to have systems prepared to face the challenges of a dynamic and uncertain world requires us to leave more space to scientists in the decision-making process.

The ultimate recommendation is that we must go beyond the time of poorly built walls or hospitals without electricity and be oriented towards the future to better face the problems of the present. To do this, our States should consider funding prospective research programs on the possible scenarios of our health system by 2030 or even 2050. The results of research could improve or correct the orientations of the national strategy, help to rethink governance of the sector, and even prepare us for medicine in the era of artificial intelligence.

Pathé Dieye, research fellow at Think Tank WATHI

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